Articles: critical-illness.
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Continuous dual oximetry combines pulse and venous oximetry to provide real-time information about oxygen utilization and pulmonary function. The authors undertook this study to examine the accuracy, utility, and limitations of the technique in surgical critical care. Twelve critically ill patients underwent placement of a modified pulmonary artery catheter and a pulse oximeter, both connected to an on-line computer. ⋯ Further, the continuous oxygen extraction ratio (O2EI) and mixed venous oxygen saturation (SpvO2) correlated with the oxygen utilization coefficient (O2EI:r = 0.6, p less than 0.01; SpvO2, r = 0.76, p less than 0.01). Computer modeling of ventilation-perfusion index found limitations in accuracy that occur at high arterial oxygen saturations and when pulse oximetry errors are present. The authors conclude that (1) Continuous dual oximetry offers a significant advantage over routine blood gas analysis for monitoring cardiopulmonary parameters in critically ill patients because of its real-time display; (2) Oximeter-derived determinations parallel traditional parameters; and (3) The most significant technical limitations occur primarily at high arterial saturations and with pulse oximetry errors.
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Transthoracic echocardiography is an easily accessible, non-invasive imaging procedure for evaluation and follow-up of critically ill patients. It is particularly helpful in evaluating patients with thoracic pain, low-output syndrome or heart murmur, and has prognostic value in acute myocardial infarction. It makes a diagnostic contribution in 60 to 90% of cases, and has therapeutic implications in 50 to 65%. New ultrasound technics are briefly discussed.
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Comparative Study
Prospective comparison of clinical judgment and APACHE II score in predicting the outcome in critically ill surgical patients.
Prospective identification of patients who will not survive has been proposed as a means of limiting utilization of medical resources including critical care. This study prospectively compared prediction of outcome for surgical ICU patients by clinical assessment and the APACHE II score. Five hundred seventy-eight patients were assessed within 24 hours of admission by the ICU attending physician and predicted to live or die. ⋯ Over 40% of patients predicted to die by both methods actually survived. This study demonstrates that clinical assessment is superior to APACHE II in predicting outcome in this group of surgical patients, although the difference is small. In addition, this study suggests that neither clinical assessment nor the APACHE II score, when obtained within 24 hours of admission, is very reliable at predicting which surgical ICU patients will die.
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Critical care medicine · Jun 1992
Outcome of intensive care of the "oldest-old" critically ill patients.
To determine the short-term and long-term outcome of critically ill "oldest-old" (greater than or equal to 85 yrs) patients. ⋯ These findings suggest that age alone may be an inappropriate criterion for allocation of ICU resources.
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Comparative Study
Patterns of sedation and analgesia in the postoperative ICU patient.
Control of pain, discomfort, and agitation is an integral part of the postoperative management of critically ill patients. We examined the sedative and analgesic practices in a surgical ICU during two six-month periods, one in 1986-1987 and the other in 1989-1990. Narcotics, especially morphine and Fentanyl, were the most commonly used drugs. ⋯ The use of midazolam during the second survey period was associated with a reduced dose of narcotics in artificially ventilated patients receiving continuous intravenous Fentanyl and morphine. The use of epidural Fentanyl, especially following thoracic surgery, was greatly increased during the second study period. More work is needed to assess the effects and effectiveness of ICU sedative and analgesic regimens.